Comparison of the Efficacy and Safety of Transarterial-Chemoembolization versus Radiofrequency-Ablation for Hepatocellular Carcinoma within Milan Criteria: A Propensity Score-Matching Study.

Objective: This study aims to compare the efficacy and safety of transarterial chemoembolization (TACE) and radio-frequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) within the Milan criteria. Materials and Methods: 162 patients with HCC who underwent TACE (n=97) or RFA (n=65) from February 2011 to December 2024. A matched cohort composed of 88 patients was included after propensity score matching (PSM). The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS) and safety. Results: Baseline characteristics were balanced between the two groups after propensity score matching. Before matching, the 1-, 3-, and 5-year OS rates were 71.0%, 48.7%, 34.1%, respectively, in the TACE group and 87.0%, 69.5%, 63.1%, respectively, in the RFA group (P = 0.006). The 1-, 2-, and 3-year PFS rates were 37.1%, 25.1%, 18.3% in TACE group, and 52.6%, 43.3%, 40.6% in RFA group (P=0.009). After matching, the 1-, 3-, and 5-year OS rates were81.2%, 48.1%, 37.1%, respectively, in the TACE group and 88.6%, 65.6%, and 54.6%, respectively, in the RFA group (p=0.15). The 1-, 2-, and 3-year PFS rates were 33.3%, 20.5%, 17.5% in TACE group, and52.3%, 40.2%, 37.8% in RFA group (P=0.036). Before and after PSM, the incidence of major complications (before PSM P=0.306, after PSM P=0.08) and length of hospital stay (before PSM P=0.25, after PSM P=0.406) were similar between the two groups. Conclusion: In the treatment of HCC within the Milan criteria, RFA demonstrated a superior median PFS compared to TACE, although there was no significant difference in OS between the two therapies.